1. Paediatric Nephrology

2. Teaching website • http://paedstudent.cardiff.ac.uk

5. UTI – cumulative incidence

6. When to suspect a UTI • Infants • Pyrexia (>38.5oC) • Poor feeding • Vomiting • Abdominal discomfort • Febrile seizure

7. When to suspect a UTI (2) • Older children • Frequency • Dysuria • Wetting • Abdominal pain • Pyrexia

8. Diagnosis • Collect a urine specimen • MSU • Clean catch specimen • Bag specimen • Catheter specimen • Suprapubic aspirate • Pad specimen

10. Leucocyte esterase • Identifies presence of white blood cells • High sensitivity for UTI but low specificity

11. Nitrite test • Reliable sign of infection when positive • BUT high false negative rate • Urine has to have been in the bladder for at least an hour. This lowers the false negative rate.

12. Use of both nitrite & leucocyte esterase tests Has not replaced urine culture in patients suspected of having a UTI.

13. What do you do with the urine?

14. Aims of treatment • Prevention of renal scarring • Achieved through prompt initiation of antibiotic therapy, particularly in those groups at highest risk • Infants • Children with vesicoureteric reflux

16. Ultrasound - Normal

17. Ultrasound - Hydronephrosis

18. Ultrasound - Scarring

19. DMSA scan - normal

20. DMSA - scarring

21. DMSA - scarring

22. MCUG - normal

23. MCUG - normal

24. MCUG – R sided grade II VUR

25. MCUG – Bilateral VUR

26. MCUG – Bilateral VUR

27. Management of VUR • Antibiotic prophylaxis until 4 -5 years old • Surgery if continue to get UTIs • Reimplantation • Injection of Deflux

33. IMPORTANT MESSAGE • Only do an investigation if the result will potentially alter your management of the patient.

34. Any questions?

36. Nephrotic syndrome Triad of: • Heavy proteinuria • Hypoalbuminaemia • Oedema

39. Normal glomerulus (em)

40. EM showing foot process fusion

41. Interstitial fluid Ph - Hydrostatic pressure Po - Oncotic pressure

42. Mechanisms of oedema formation (2) • Increased hydrostatic pressure • Hypervolaemia • Increased venous pressure • Reduced oncotic pressure • Hypoalbuminaemia • Increased capillary permeability • Sepsis

43. Complications • Oedema • Hypovolaemia • Cool peripheries • Prolonged capillary refill time • Abdominal pain • Increased blood pressure • Infection • Hypogammaglobulinaemia

44. Complications (2) • Hypercoaguable state • Raised haematocrit • Loss of anti-thrombin III

45. VQ scan in nephrotic patient

46. Complications (3) • Hyperlipidaemia • Hypothyroidism

47. Treatment • Lots of steroids

48. Any questions?

49. Red cell cast

50. Tubules filled with red blood cells – source of red cell casts